Educating healthcare professionals on spurious medicines in India

Candida C. Halton1, Luc Besancon2, Pradeep Mishra3

Background

The World Health Professions Alliance (WHPA) brings together the global organizations representing the world’s dentists (FDI), nurses (ICN), pharmacists (FIP), physical therapists (WCPT) and physicians (WMA) and speaks for more than 26 million health care professionals in more than 130 countries.

  • WHPA works to improve global health and the quality of patient care and facilitates collaboration among the health professions and major stakeholders.
  • WHPA convened the Indian Medical Association (IMA), the Indian Nursing Council (INC) and the Indian Pharmaceutical Association (IPA) to devise and execute a campaign to raise awareness and increase education on this issue.
  • Spurious (also known as counterfeit) medicines are an acknowledged threat to patient safety.
  • The project, which ran from October 2013 to March 2015, was conducted in collaboration with Pfizer Inc.

Rationale

To gather evidence, determine appropriate action and pilot intervention/s to improve understanding of the threat of spurious medicines in India.

Method

Supported by WHPA, the IMA, INC and IPA held three advisory board meetings.

  1. The purpose of the first meeting was to gather evidence to direct the campaign. The Indian Healthcare Professional Associations heard inputs from Government, private and public sector stakeholders. Following a workshop it was agreed to commission public and healthcare professional (HCP) research to determine awareness levels.

  2. The second meeting reviewed the qualitative research. This showed poor levels of consumer and HCP awareness on the issue. It was determined that initial education work should be amongst HCPs, to avoid creating unintentional fears amongst the public. The group agreed scope of the training and resources to be made available through WHPA. The group also commissioned the Spurious Medicines Handbook.

  3. The third and final meeting reviewed pilot results and made recommendations for future work.

The Spurious Medicines Handbook

The handbook was written to be a ‘ready reckoner’ or ‘Go to Guide’ on spurious medicines. It contains stories, news and facts on the issue, alongside information on prevention, detection and reporting.

It covers the threat to patient safety, impact on individuals, society and healthcare professionals. Finally, it reviews global and local strategies and best practices for addressing the problem.

The handbook is available from WHPA 10,000 copies have been distributed through healthcare associations to members, influencers, leaders, policy makers, students and other important stakeholders.

The Spurious Medicines Handbook

Results

Pilot education interventions were developed and conducted through the IMA, INC, IPA and Apollo Hospitals. Sessions took place in late 2014/early 2015.

  • 677 Indian Healthcare Professionals were trained. Graph showing that 50% of attendees were pharmacists, 37% were nurses, 10% were doctors and 3% were distributers.
  • Data collected show change in knowledge score (positive, but non-significant), and provide input for future trainings.
  • A Healthcare Professional Handbook on Spurious Medicines was published and distributed to 10,000 HCPs.

Indian Medical Association (IMA)

The IMA trained state branch leaders (n=70). They participated in a 30-minute live training session, conducted using adapted WHPA material, with a pre and post-test questionnaire.

Information about the issue of spurious medicines and a brief training overview was also disseminated via the IMA e-newsletter and website.

Traning session participants: state branches leaders, including IMA national leaders.

Indian Pharmaceutical Association

The IPA conducted four training sessions, targeting:

  1. Community pharmacists (n=140) in Goa.
  2. Pharmacists (n=43) and distributers (n=16) in Ulhasnagar.
  3. Community pharmacists (n=18) and hospital pharmacists (n=12) in Annamalai.
  4. Community pharmacists (n=75) in Navi Mumbai.

Training session duration was 3 hours, materials were adapted from WHPA assets and, where appropriate, included information on Good Distribution Practice. Guest speakers participated in some training sessions, providing insights and case studies which participants found valuable.

The sessions received coverage in Pharma Times and IPA CPD eTimes, and in local media.

Training session in Ulhasnagar. Guest speaker FDA Assistant Commissioner Thane District.

Indian Nursing Council

The INC ran a stand-alone training meeting at the Civil Hospital Campus, Ahmedabad, Gujarat. Nurses who participated in the training (n=200) ranged in experience from Senior Nurses to more junior ‘Freshers’. Content and materials were adapted from WHPA, with a greater focus on the nurses’ role – additional input provided by Senior Nurses and Nursing Superintendents.

Training session duration 4.5 hours. Presentations were given in English with discussion in Gujarati.

Apollo Hospitals

Two 45-minute training sessions were conducted, one for Nurses (n=52) and one for pharmacists (n=51). Session content was consistent across both groups: powerpoint presentation and facilitated discussion, and had been adapted from WHPA assets.

A pre and posttest questionnaire was used to track outcomes. This included a free text box asking ‘what role would you like to play to combat the problem of spurious medicines?’.

Data from this is being used to determine future work by Apollo Hospitals in this area of spurious medicines.

Attendees at the Apollo Hospitals training session.

Attendees at the Apollo Hospitals training session.

Discussion

Learnings from pilot education interventions

During the third advisory board meeting, the group used a facilitated workshop to discuss shared learnings from the training format and materials.

  • Overall the education pilots had been valuable and well received by the audiences.
  • Knowledge about spurious medicines was generally low, with a degree of confusion about the issue.
  • The training curriculum was appropriate. A briefer definition of ‘Spurious Medicines’ would aid clarity. Case studies, examples and personal stories were popular with participants.
  • The visual inspection tool information could be provided as a hand-out / takeaway for participants.
  • The pre and post-test knowledge assessment could be simplified.
  • A teaser campaign highlighting the issue to participants prior to the training would add interest and engagement.
  • It is challenging for participants to find the time to attend trainings, so linking to other topics or including the training within other activities is preferable.

What is the enduring impact of the training?

  • Each of the Indian partner Associations and Apollo Hospitals are committed to continue education and training amongst their constituencies on the issue of Spurious Medicines. This includes activities during awareness weeks, using existing publications and communication platforms as well as physical training sessions.
  • Apollo has instigated a new system to aid detection of possible spurious medicines reaching the hospital supply chain: the 25 most frequently ordered medicines will have a permanent sample in the hospital pharmacy which will be used as a visual inspection reference.

Conclusion

Collaboration between health professional associations led to improved knowledge and awareness of the threat of spurious medicines.

Disclosure of Interest: C. Halton Employee of: I am a self-employed consultant, and provide contracted project management and communication services. My clients include Pfizer Inc., L. Besancon: None Declared, P. Mishra: None Declared


  1. on behalf of WHPA, London, United Kingdom. ↩︎

  2. General Secretary and CEO, FIP, The Hague, Netherlands. ↩︎

  3. on behalf of WHPA, Delhi, India. ↩︎